Household Characteristics, Cost of Illness and Coping Mechanism of Families of Hospitalized Acute Encephalitis Syndrome Children: A Mix Method Study

Background: AES is responsible for causing high social and economic burden to the affected families. The study was conducted to know the household characteristics, cost of illness and coping strategy adopted by the family members of AES children admitted to a tertiary care facility in Assam, India. Methods: It was a sequential exploratory mixed method study, with a cross-sectional survey among AES chil-dren and their guardians, followed by In Depth interview. Results: Out of 51 cases 55% were male. The median age was 11 years. 53% of the families belonged to lower socioeconomic class. 96% of families reported to reside in rural areas. Commonly reported household assets were mobile phone 94%, bicycle 86%, television 31% and motorcycle 29%. Three major themes were emerged to contribute towards economic burden. The first major theme is “Direct cost” due to patient trans-portation cost (mean Rs 1161.00) and hospital costs: mostly due to medicinal cost (mean Rs1955.00), investi-gational cost (mean Rs 2920.00) and food cost (mean Rs 8375.00). The second theme “Indirect cost” is due to work days loss: 100% care providers had missed work days during hospital stay of their children and 84% had missed work days during post hospital care. The third theme is “Inherent cost spotted through coping mechanisms” which mostly 94% included borrowing money from the market and 31.4% selling household assets. Conclusion: Cost of illness is a huge burden to the AES afflicted families which demands reforms in health care financing and reimbursement in current context.

Study on home care needs and care resource integration expectations of elderly patients after hip fracture surgery: a mixed-method study / 中国实用护理杂志

Objective:To investigate the home care needs and home resource integration expectations of elderly patients after hip fracture surgery so as to provide health care guidance after discharge.Methods:A mixed study method of consistent parallel design was used to conduct semi-structured interviews in 15 elderly patients after hip fracture surgery. Meanwhile, convenient sampling method was used to select elderly patients after hip fracture surgery to conduct health survey with interRAI-HC(International Resident Assessment Instrument Home Care), and comprehensive data results were analyzed.Results:Through the analysis and induction of the interview data, two main themes were extracted: the diversification of home care needs and the lack of integration of home service resources. There were 25 health problems in the elderly after hip fracture surgery. Health problems mainly focus on ADL limitation, insufficient social activity, limited social interaction, clinical health problems (fall risk, malnutrition, pain, cardiovascular and respiratory problems, weakness, fatigue), etc.Conclusions:For elderly patients after hip fracture surgery, it is necessary to strengthen the rehabilitation guidance at discharge, integrate home care resources to provide diversified nursing services in the transitional stage, promote the formation and continuity of patients' rehabilitation behavior, and improve the clinical outcome of patients.

The specific outcome Assessment Modal of acupuncture and Tuina treatment for pain / 国际中医中药杂志

Acupuncture and Tuina are the main non-drug therapies for low back pain, which are recommended by the guidelines. Acupuncture and Tuina can alleviate pain, which is regarded as conditional specific outcome, and improve mental, emotional problems, as non-conditional specific outcomes. There are some problems of the outcome assessment of acupuncture and Tuina treatment for pain such as insufficient evaluation of specific effect and unclear evaluation of characteristic outcome. Therefore, the key to above problems is to construct a Specific ouTcomE Assessment Modal of acupuncture and Tuina treatment for pain (STEAM-A&T) based on the qualitive and quantitative methods. By describing the experience, narrative expression, feelings and needs of patients who receiving acupuncture and Tuina treatment, the item banks of acupuncture and Tuina treatment effect are constructed, and the characteristic outcome of acupuncture and Tuina for pain will be screened, and then the relationship model among outcomes is constructed and optimized, which reflected the characteristics of acupuncture and Tuina for pain from multiple dimensions, multiple levels and multiple views. We reveal the relationship between the outcome of acupuncture and Tuina for pain. It will provide a new theory and methods for the construction of specific outcome assessment modal of Traditional Chinese Medicine.

Components of intersectoral partnerships and positive health outcomes in highly vulnerable areas in São Paulo/Brazil: a mixed methods study / Elementos constitutivos das parcerias intersetoriais e resultados positivos de saúde em áreas de alta vulnerabilidade social em São Paulo/Brasil: um estudo misto

Introduction: Studying highly vulnerable areas is challenging, but it can support intersectoral actions to tackle the social inequalities prevalent therein.Objective: This research explores the relationship between the central constituents of intersectoral collaborations and the positive results of intersectoral actions in areas of high social vulnerability in São Paulo, Brazil. It also analyzes the perception of professionals in basic health units (BHU) regarding the results related to those actions.Methods: This study employed methodological triangulation and the mixed method sequential explanatory strategy. First, we applied an online form validated by face and content for BHU managers. Then, we used the SPSS Statistics software to perform nonparametric tests. Statistical significance was set at p < 0.05, and 95% confidence intervals and phi coefficients were calculated. After identifying the units that carried out intersectoral actions with different partners, we conducted focus groups in four of them with 26 health professionals until saturation. Finally, we integrated quantitative and qualitative data.Results: The bivariate analysis showed that the creation of healthy habits and environmental improvements were associated with the central components of intersectoral partnerships. The content analysis presented steps to elaborate the actions and arrive at the results from the central elements. Integration of the results explained how the results related to the actions were elaborated, considering the central elements of the collaborative processes.Conclusions: Partners negotiate with patients or communities to adhere to the care provided through the collaborative process. However, they recognized that they needed to evaluate the proposed actions regularly.

Introdução: Estudar áreas de alta vulnerabilidade é desafiador, mas pode subsidiar ações intersetoriais para o enfrentamento das desigualdades sociais prevalentes nestas.Objetivo: Esta pesquisa explora a relação entre os constituintes centrais das colaborações intersetoriais e os resultados positivos das ações intersetoriais em áreas de alta vulnerabilidade social em São Paulo, Brasil. Também analisa a percepção dos profissionais das Unidades Básicas de Saúde sobre os resultados relacionados a essas ações.Método: Aplicamos uma triangulação de métodos. A estratégia explicativa sequencial de método misto foi utilizada seguindo os seguintes passos: Primeiramente, aplicamos um formulário online validado por face e conteúdo para gestores de UBS, e 60,7% dos gestores responderam. Utilizou-se o software SPSS Statistic para realizar o teste não paramétrico. Valores de p <= 0,05 foram considerados estatisticamente significantes. O intervalo de confiança de 95% e o coeficiente Phi também foram calculados. Após identificar as Unidades que realizavam ações intersetoriais com diferentes parceiros, realizamos grupos focais em quatro delas com a participação de 26 profissionais de saúde até a saturação. Por fim, integramos os dados quantitativos e qualitativos.Resultados: A análise bivariada mostrou que a criação de hábitos saudáveis e melhorias ambientais estiveram associadas aos elementos centrais que constituem as parcerias intersetoriais com significância estatística (p <= 5). A análise de conteúdo apresentou os passos para elaborar as ações e chegar aos resultados a partir dos elementos centrais. Ao integrar os resultados, respondemos como foram elaborados os resultados relacionados às ações, considerando os elementos centrais dos processos colaborativos.Conclusão: Os parceiros intersetoriais negociam com os pacientes ou comunidades a adesão aos cuidados sugeridos pelo processo colaborativo. No entanto, reconhecem que precisam avaliar regularmente as ações propostas.

HIV oral self-screening test among HIV/STD/TB clinic attendees: A mixed-method pilot investigation examining merit for largerevaluation

Background & objectives: Globally, several countries consider HIV self-test as an important element in the toolbox to end AIDS by 2030. Against this background, the present investigation was conducted to pilot test the performance of an indigenous HIV oral self-test (HIVOST) and explore its acceptability. The overall purpose was to examine if this kit could serve as a promising tool and merit future larger clinical evaluation. Methods: A concurrent mixed-method investigation was undertaken during March-October 2019. One hundred and thirty two consecutive HIV/sexually transmitted diseases/tuberculosis clinic attendees were invited for participation; of whom, 100 were enrolled, and among them, 40 provided consent for qualitative in-depth interviews. The HIVOST kit assessed for its performance served as the ‘index test’, which worked on the principle of lateral flow chromatography. The results of the HIVOST were interpreted independently by the study physicians and participants at 20 min. HIVOST kit performance was assessed against the HIV confirmatory blood test result based on the national algorithm (3 rapid test or 1 ELISA and 2 rapid test) serving as the ‘reference’. Sensitivity, specificity, positive predictive value, negative predictive value and inter-rater agreement were estimated. The voices and concerns of the study participants were coded followed by identification of qualitative themes and ideas. Results: The sensitivity and specificity of the index test at the end of 20 min as interpreted by the participants were 83.3 per cent [95% confidence interval (CI): 69.8 to 92.5] and 98 per cent (95% CI: 89.4 to 99.5), respectively. Study physicians and participants independently interpreted HIVOST results with substantial inter-rater agreement (kappa value 0.88; 95% CI: 0.78-0.97). All HIVOST test strips were valid. Majority of the participants preferred saliva over blood for HIV self-test. ‘Comfort’, ‘confidentiality’ and ‘convenience’ were the perceived advantages of HIVOST. Some of the participants wished the package inserts contained ‘how-to-do instructions in local languages’, ‘expiry date (if any)’ and ‘contact helpline number’. A few of them highlighted the need for a confirmatory HIV result following oral self-test. Concerns of the participants revolved around potential self-harm following HIVOST-positive result and safe disposal of kits.Interpretation & conclusions: Two major highlights of the present investigation are (i) high level of concordance in HIVOST results interpreted by participants and physicians, and (ii) encouraging level of acceptance of HIVOST. These findings and encouraging HIVOST performance statistics lend support towards large-scale clinical evaluation of this index test.

Perspectives On Health Care Cost-Consciousness among Medical Students and Physicians

Introduction: Health care costs consciousness refers to care that aims to assess the benefits, harms and costs of interventions by the physicians. Rising health care costs have created an urgent need to improve physicians� knowledge on health care costs for providing cost conscious care. Objectives: This study was done to assess and compare the knowledge and attitude towards health care cost consciousness of the undergraduate medical students and interns. Methodology: A Mixed Method study was done using a standardized questionnaire among 388 medical students and a Qualitative approach using In-depth interviews with 15 practicing physicians and a Focus group discussion to understand their perceptions on cost-conscious care and their opinions on introducing Cost-conscious curriculum for the medical students. Data analysed using a framework analytical approach and NVivo12. Results: 84% of the students agreed that all health personnel should be familiar with health care costs, 84.5% agreed that inclusion of the health care cost consciousness in medical curriculum is important for their carrier. The themes emerged identified the various perceptions, determinants on health care costs, cost-conscious decision making and their responsibility as a physician. Conclusion: The physicians and interns strongly suggested including a structured learning on Cost-Conscious Care as a part of medical education to educate and train the future physicians.

Awareness Regarding Gestational Diabetes Mellitus among Antenatal Women of Rural West Bengal: A Mixed-method Study

Introduction: Awareness regarding Gestational Diabetes Mellitus (GDM) among antenatal women is necessary for early diagnosis and management of the disease for ensuring a safe motherhood and a healthy child. Objective: This study envisaged to assess the awareness regarding GDM and its determinants among antenatal women attending healthcare facilities in a rural area of West Bengal and to explore the perspectives of health workers with regard to gaps in proper awareness generation activities among antenatal women. Method: This mixed-method study was conducted from April 2021 to July 2021 at 4 health facilities in Singur, West Bengal. Quantitative data were collected from 195 antenatal women using a pretested questionnaire which were analysed using SPSS software. Qualitative data were collected via in- depth interviews among 6 health workers working in the health facilities and were analysed thematically. Results: Overall, 75.4% of participants were not aware of GDM. Multivariable logistic regression analysis showed that secondary education and below (AOR=3.48, 95% CI=1.63-7.42), no history of GDM among family & relatives (AOR=7.24, 95% CI=2.12-24.66), lesser number of antenatal visits (AOR=3.48, 95% CI=1.63-7.42) and non-receipt of counselling regarding GDM during antenatal visits (AOR= 3.09, 95% CI =1.45–6.58) had a significant association with poor awareness. From health workers' perspectives, lack of reorientation training, shortage of supplies for testing, and overburdening with other responsibilities were the major gaps identified in proper awareness generation activities. Conclusion: Present study revealed majority of study participants possessed poor knowledge regarding GDM. Reorientation training of health workers, organizing awareness campaigns at the community level, and relevant counselling regarding GDM during each antenatal visit should be given utmost priority for improving knowledge about the disease

Awareness and possible treatment options toward COVID-19 among selected healthcare professionals in National Capital Region

Background@#Since December 2019, SARS-CoV-2, otherwise known as coronavirus disease 2019 (COVID-19), has caused worldwide panic and is now a serious problem. As the situation worsens, the need for an official cure becomes more crucial and different methods are being considered for treating infected COVID-19 patients. @*Objectives@#This study aimed to emphasize and further elaborate on the existing and possible treatment methods against COVID-19 and assess the awareness of healthcare professionals (doctors, medical technologists, and nurses) on the treatments for COVID-19. @*Methodology@#The study utilized an exploratory sequential mixed methods design following the treatment and misinformation theories models. The respondents were selected based on inclusion and exclusion criteria and recruited through the snowball sampling technique. The study used an adapted survey questionnaire on the pathophysiology of COVID-19 and possible treatment options. Descriptive statistical analysis for quantitative data and open thematic coding is used in an online qualitative deductive data analysis. @*Results@#Based on the data, webinars, lectures, and discussions were the primary source of information among healthcare professionals. Most of the respondents showed proficiency with remdesivir among investigational selective medicines. Chloroquine was the top choice among selected repurposed drugs. They were aware of the convalescent plasma therapy that uses antibodies from the blood plasma of recovered COVID-19 patients. They were not aware of the different herbal treatments used to treat COVID-19. @*Conclusion@#Hence, chloroquine (repurposed drug), remdesivir (investigational drug), and convalescent plasma (adjunctive therapy) are the most well-known treatments for COVID-19. Most of the respondents were aware of the action and side effects of chloroquine, remdesevir, and convalescent plasma therapy.

Relation between students' expectations about their grade and metacognitive monitoring and a deeper understanding of metacognitive judgments / Relación entre las expectativas de los estudiantes sobre su nota y el monitoreo metacognitivo y una comprensión más profunda de los juicios metacognitivos

Abstract Metacognition is an important higher-order thinking process for successful learning. The present study investigated the relation between students' (N = 65) expectations about their grade (expressed as difference scores between expected grade and actual grade) and their metacognitive monitoring accuracy and bias and the extent to which these difference scores in expected grade versus actual grade predicted accuracy and bias, employing an explanatory sequential quantitative(QUALITATIVE mixed method research design. The study also explored how students develop and refine metacognitive judgments and the types of strategies they employ during this process. Results revealed that there were significant relations between difference scores in expected grade versus actual grade and accuracy and bias (r = .02 to r = .89 in absolute value), and that difference scores significantly predicted both accuracy (R 2 = .52) and bias (R 2 = .69). Further, qualitative findings revealed that there were differences in how students developed and refined metacognitive judgments as a function of four aspects of learning: effort/preparation, strategy selection/implementation, planning, and evaluation. Educators should explicitly teach metacognitive monitoring skills to improve students' self-regulated learning.

Resumen La metacognición es un proceso importante de pensamiento de orden superior para un aprendizaje exitoso. El presente estudio investigó la relación entre las expectativas de los estudiantes sobre su nota (expresadas como puntuaciones de diferencia entre la nota esperada y la nota real) (N = 65) y su precisión y sesgo de monitoreo metacognitivo y el grado en que estas diferencias en la nota esperada versus la nota real predijeron la precisión y el sesgo, empleando un diseño de investigación secuencial explicativo cuantitativo-CUALITATIVO de método mixto. El estudio también exploró cómo los estudiantes desarrollan y refinan juicios metacognitivos y los tipos de estrategias que emplean durante este proceso. Los resultados revelaron que había relaciones significativas entre las diferencia de puntajes en la nota esperada versus la nota real y la precisión y el sesgo (r = .02 to r = .89, en valor absoluto), y que estas diferencia de puntajes predijo significativamente tanto la precisión (R 2 = .52) como el sesgo (R 2 = .69). Además, los hallazgos cualitativos revelaron que había diferencias en la forma en que los estudiantes desarrollaban y refinaban juicios metacognitivos en función de cuatro aspectos del aprendizaje: esfuerzo / preparación, selección / implementación de estrategias, planificación y evaluación. Los docentes deben enseñar explícitamente habilidades de monitoreo metacognitivo para mejorar el aprendizaje autorregulado de los estudiantes.

The Importance of Clinical Documentation in the MalaysianDRG Casemix System: A Sequential Explanatory Mixed-Method Study of Ministry of Health Hospitals in Malaysia

@#Introduction: The Ministry of Health (MOH) implemented the MalaysianDRG casemix system in 2010, and two national target indicators on the accuracy and completeness of clinical documentation were introduced to measure its performance. This study aims to show the trend of casemix performance in MOH hospitals and to explore the challenges in meeting these targets. Methods: The study design was sequential explanatory mixed-method design. First, a cross-sectional study described the trend of casemix performance in five MOH hospitals in Malaysia. Second, a single holistic case study of the hospital with the lowest casemix system performance was conducted to explore the perceptions of clinicians regarding the MalaysianDRG casemix and the challenges pertaining to clinical documentation. Purposive sampling was employed, and the case study data collection was carried out using in-depth-interviews, observation, and document reviews. Results: Two hospitals achieved the target in the accuracy of clinical documentation for the main condition (≥90%). For completeness in clinical documentation, four out of five MOH hospitals performed below the target (≤ 60%). Thematic analysis of the data found poor commitment of clinicians towards casemix and a multitude of obstacles in performing clinical documentations. Conclusion: After a decade of its implementation, the performance of the MalaysianDRG casemix system in MOH hospitals is still moderate due to inaccurate and incomplete clinical documentations. The study findings may be used to spread awareness and devise tailored solutions to assist clinicians in paving the way towards future excellence in MalaysianDRG casemix system.

Evaluation of the college-based HIV/AIDS education policy in Beijing, China: a mixed method approach

BACKGROUND@#From 2010 to 2015, there was a twofold growth of new HIV/AIDS infection in Beijing among young students aged 15-24. HIV/AIDS education was found effective in promoting positive behavior change related to HIV/AIDS prevention. However, little evidence was found on the evaluation of HIV/AIDS education policy. This study aimed to evaluate the college-based HIV/AIDS education policy in Beijing.@*METHODS@#By using a mixed method approach, the current study reviewed college-based HIV/AIDS education policy at national level and in Beijing from 1985 to 2016 and conducted policy content analysis to evaluate the policy ability to structure implementation. Cross-sectional surveys in 2006 and 2016 were used to evaluate college's implementation of relevant policies. T test, χ test, and logistic regression were used to analyze college students' perception of HIV/AIDS education provided in their colleges and their knowledge of HIV/AIDS and their risk factors.@*RESULTS@#Fourteen pieces of national policy and four pieces of Beijing's policy were identified. Policy's ability to structure implementation was at moderate level. The percentage of students in Beijing who ever perceived HIV/ADIS education at colleges decreased from 71.14 to 39.80%, and the percentage of students with comprehensive knowledge of HIV/AIDS dropped from 50.00% in 2006 to 40.42% in 2016.@*CONCLUSIONS@#HIV/AIDS education in college had drawn considerable attentions from the Chinese government, while the policy implementation needs further strengthening.

Views on Precision Medicine among Health Professionals in Korea: A Mixed Methods Study

Quality of life of patients with head and neck cancer: A mixed method study

Aim of the Study: The current research was conducted with the aim of determining the quality of life of head and neck cancer (HNC) patients using mixed method approach. Methods: A mixed method triangulation design (QUAN + QUAL) was adopted in the study. Quantitative data were collected among 54 and qualitative data were collected till data saturation using nested sampling technique. Data were collected from seven oncological wards of two tertiary care hospitals during the 4th week of radiation therapy. Quantitative data were collected through functional assessment of cancer therapy: head and neck, and a semi-structured interview schedule was adopted to elicit their experiences. Quantitative and qualitative data were compared during the analysis phase. Both qualitative and quantitative data were depicted in meta-matrices. Results: Results showed that the most affected domains were functional well-being followed by HNC subscale. Similar findings were observed in narrative description of participants. Most focused experience was pain, and difficulty in eating and swallowing was experienced due to pain. Their verbal communication was inefficacious due to loss of voice and tone. Moreover, communication was difficult owing to changes in the oral mucous membrane and pathology. Conclusion: Patients with HNC suffer from varying degrees of psychosocial problems, and it is important to identify the psychosocial adjustment of the patients since the symptoms are sufficient to lay heavy burden

Relationship Between Current Status of Education and Training at Home-visit Nursing Service Agencies in Tokyo and Their Sizes: Mixed Method Research Using Text Mining / 日本プライマリ・ケア連合学会誌

Objectives: To clarify the current status of education and training at home-visit nursing service agencies, and to compare them by size.Methods: A convergent mixed method design was employed to analyze national administrative data of home-visit nursing service agencies in Tokyo in 2015. The categories regarding the training institution and its themes were created based on the detailed description of the training. For qualitative analysis, the corresponding analysis was conducted for the size of the agencies, and the utilization rate and scale of training for each theme were analyzed quantitatively. The qualitative and quantitative results were then integrated.Results: A total of 311 agencies were included in the analysis. Eight categories for training institutions, such as "medical institutions", were identified among the medium-sized agencies, with the smaller agencies having higher utilization rates. Among the 38 categories for training themes, "psychiatric nursing" and "child health nursing" were found among medium-sized or larger agencies. Moreover, larger agencies had higher utilization rates of training for these themes.Conclusions: We identified the training institutions and the themes of the home-visit nursing service agencies in Tokyo. Home-visit nursing service agencies used many training institutions, regardless of size, whereas the themes were related to agency size.

Barriers of Treatment-Supporters for DOTS under RNTCP in District Shahdol, India: A Mix-Method Study

Background: One of the challenges of Revised National Tuberculosis Control Programme (RNTCP) has been that it has not been able to impart adequate knowledge, satisfactory attitude and desirable practices among treatment-supporters of rural and tribal communities. Present study was planned to explore the knowledge, attitude, practice and perceived barriers related to Directly Observed treatment (DOT) provision among the treatment-supporters of Shahdol district, Madhya Pradesh in 2018. Methods: Mixed–methods study design of triangulation type was used among 30 community- based treatment-supporters of DOT from Sohagpur tahsil of district Shahdol of Madhya Pradesh, India. The cross-sectional quantitative component assessed the knowledge, attitude and practices and three focus-group discussions were used to explore the perceived barriers related to DOT provision. Results: ‘Adequate knowledge’ related to DOT provision was found in 37% of treatment- supporters, while 40% had “satisfactory attitude” and 60 % had “satisfactory practice” related to DOT. The focus-group discussions revealed, ineffective training, lack of supportive supervision, insecure monetary incentive, distant Public Health Institution/Designated Microscopic Center, language barrier and patient related stigma to TB disease as main perceive challenges related to DOT. Conclusion: Study revealed inadequate knowledge and unsatisfactory attitude and practice related to DOT provision among treatment-supporters. Effective training, making services accessible to patient, making RNTCP form in Hindi language and strengthening of honorarium disbursement mechanism are urgently required.

The Public’s Evaluative Opinions on the Approval or Disapproval of Separation of Dispensing and Prescribing Functions ─A Mixed Method / 社会薬学

The purpose of this research was to clarify the factors influencing the approval or disapproval and evaluative opinions of the public concerning separation of dispensing and prescribing functions. We conducted a Web survey with 2006 participants (September 2016). We conducted multiple logistic regression analysis and quantitative analysis of freely recorded their reasons about approval or disapproval. The approval rating was 29.2％ in persons who had had some prior experience with at the pharmacies (n＝1,778) and 41.9% in participants who made regular clinic visits and always filled prescriptions at the pharmacy (n＝430). Multiple logistic regression analysis of the data of participants who visited pharmacies (n＝1,778), identified that compared to participants who experienced side effects (OR＝1.34), the frequency of used pharmacies (OR：Odds ratio＝1.47), the filling burdened by having to fill prescriptions at the pharmacy (OR＝0.19, 1/OR＝5.18), there was a significant positive association for the approval. Analysis of qualitative data of the group that approved identified many labels related to ‘quality of results’, however no labels related to ‘quality of results’ were generated in the group which disapproved. Public approval or disapproval of non-hospital based prescription is mainly determined based on the burden or inconvenience incurred (due to waiting times, mobility-incurred time and energy, inconvenience associated with travel, inconvenience of repeated visits) when filling prescriptions at the pharmacy rather than on opinions regarding the pharmacy’s drug therapy service. Measures are required to increase the level of merit compared to the burden experienced in the use of pharmacy.

Features of Social Capital for women through microfinance in rural Burkina Faso - Exploratory study with mixed method / 国際保健医療

Objectives  A number of evidence suggest that the society with minimal health inequality has abundant Social Capital(SC) and SC is related to participation to microfinance, however, empirical studies on the association between health and SC are limited. This study aims to explore the features of SC for women who participate to microfinance in rural Burkina Faso, in order to discuss about response towards health inequality reduction. Methods  Exploratory sequential design mixed method was adopted. Photo Voice was conducted with 11 women living in a village of A health district to explore social support functions that contribute to maternal and child health, and data were analyzed inductively. A survey was conducted for 563 women aged 20-45 years living in the rural villages of A health district with questionnaire developed by using qualitative study results, and descriptive statistics and groups comparison were performed.ResultsAssistance with cash loan or transportation to clinic, information provision on the effects of family planning, and reporting members’ physical condition to their husband were extracted as SC functions for women in microfinance. Quantitative study elucidated that the proportion of membership of microfinance is only 14.4% and that quantity of social support was significantly greater in membership of microfinance, in particular financial support. Information support was not so exchanged contrary to qualitative research results. Exchange of social support was not limited between microfinance members but mainly with extended family.Conclusions  SC through microfinance consisted of physical, information and emotional support, which reflected on the socio-economic status and health system in rural Burkina Faso. The member had a plentiful SC but exchange of SC was not limited among membership. In order to use the effectiveness of SC through microfinance for health inequality reduction, generalization of SC throughout community including non-membership should be considered.

Análise do desempenho das equipes de saúde bucal na estratégia saúde da família no Brasil: um estudo misto / Evaluating primary dental care in Brazil: a mixed methods study

A Estratégia Saúde da Família (ESF) constitui o principal modelo de organização da Atenção Primária (APS) no Brasil. A Saúde Bucal foi inserida na ESF em 2001 com a criação das equipes de saúde bucal (ESB) como área prioritária diante da necessidade de melhorar as condições de saúde bucal da população. Na última década, observou-se uma expressiva expansão da ESF com o alcance de serviços chegando a cerca de 63% da população brasileira em 2016. Com o objetivo de avaliar a qualidade dos serviços da ESF, o Ministério da Saúde lançou em 2011 o Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). O principal desafio do PMAQ é instituir uma cultura de avaliação entre os profissionais e gestores da ESF que monitore e avalie processos e resultados das equipes. O objetivo desse estudo foi descrever as ações de APS realizadas pelas ESB no Brasil e compreender aspectos que levam ao diferente desempenho das ESB. Para isso, foi desenvolvido um estudo misto explanatório sequencial. Na fase quantitativa, análise descritiva e de cluster foram aplicadas em dados do PMAQ-AB para descrever a produção de 12.403 ESB. Também foi utilizada a Teoria de Resposta ao Item (TRI) para avaliar as qualidades psicométricas de 20 questões de saúde bucal do PMAQ-AB. Resultados da TRI foram usados para selecionar ESB com desempenhos extremos para a próxima fase. Na fase qualitativa foi realizado um estudo descritivo em dez ESB da região metropolitana de Belo Horizonte com desempenhos extremos classificados pela TRI na fase anterior. Os resultados quantitativos demonstraram que as ESB realizam procedimentos clínicos da odontologia básica, mas fazem menos reabilitação com próteses e coordenação do cuidado de câncer bucal. A análise da TRI demonstrou que os itens do questionário foram insuficientes para discriminar ESB de alto e baixo desempenho. No entanto, foi observado que ESB de alto desempenho tendem a realizar ações de prevenção e acompanhamento de câncer e confecção de prótese na APS. Os resultados da fase qualitativa confirmaram que ESB de alto desempenho tendem a trabalhar mais ações de promoção e prevenção de câncer de boca, inclusive utilizando contatos pessoais para encaminhar pacientes para serviço especializado. Já em relação à questão da prótese na APS, os dados qualitativos confirmaram os achados quantitativos e demonstraram que ESB de alto desempenho fazem prótese na APS, garantindo a reabilitação do usuário

The Family Health Strategy is the main organizational model of primary health care in Brazil. Dental care was included in the FHS in 2001 as a priority area due to the need to improve the oral health status of the population, and the oral health teams were created. In the last decade, there was a significant expansion of the ESF with the range of services reaching about 63% of the population in 2016. In 2011, the Brazilian Ministry of Health launched a program to assess the quality of FHS Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica ­ PMAQ-AB. The main challenge of PMAQ-AB was to stimulate a culture of evaluation among FHS professionals and managers who evaluate processes and outcomes of the teams. This study aimed to describe the actions performed at primary health care by oral health teams in Brazil and to understand factors that contribute to different performance of each team. For this, a mixed sequential explanatory study was developed. In the quantitative phase, we undertook descriptive statistics and cluster analysis to describe the production of 12,403 OHTs, and applied Item Response Theory (IRT) to assess survey's 20 dental care questions psychometric properties. IRT results were used to sample OHTs with extreme scores performance to the next phase. In the qualitative phase, we used descriptive approach applying thematic analysis in 10 dentists from extreme performance OHTs. Quantitative results showed OHTs provided basic dentistry clinical care, but underprovided rehabilitation with dentures and oral cancer care coordination. IRT analysis showed survey limitation to discriminate OHTs performance, except for rehabilitation with dentures and oral cancer-related items that tend to discriminate high-performance OHTs. Qualitative data showed barriers to access oral health services and failures for integrating oral cancer delivery services. Dentists' empathy and altruism determine the quality of oral cancer care coordination by means of their own network to refer patients suspect of oral cancer. OHTs that deliver dentures know better the population rehabilitation needs. Mixed method results showed the improvements in oral health services in Brazil, but pointed that in low performance OHT, patients face multiples barriers to access services. Also, low performance OHT failed to following oral câncer patients, and provided dentures

A pragmatic observational feasibility study on integrated treatment for musculoskeletal disorders: Design and protocol / 中国结合医学杂志

<p><b>BACKGROUND</b>Musculoskeletal disorders (MSD) comprise a wide range of conditions, associated with an enormous pain and impaired mobility, and are affecting people's lives and work. Management of musculoskeletal disorders typically involves a multidisciplinary team approach. Positive findings have been found in previous studies evaluating the effectiveness of complementary therapies, though little attention has been paid to evaluating of the effectiveness of integrated packages of care combining conventional and complementary approaches for musculoskeletal conditions in a National Health Service (NHS) setting.</p><p><b>OBJECTIVE</b>To determine the feasibility of all aspects of a pragmatic observational study designed: (1) to evaluate the effectiveness and cost effectiveness of integrated treatments for MSDs in an integrated NHS hospital in the UK; (2) to determine the acceptability of the study design and research process to patients; (3) to explore patients' expectation and experience of receiving integrated treatments.</p><p><b>METHODS</b>This is an observational feasibility study, with 1-year recruitment and 1-year follow-up, conducted in Royal London Hospital for Integrated Medicine, University College London Hospital Trust, UK. All eligible patients with MSDs newly referred to the hospital were included in the study. Interventions are integrated packages of care (conventional and complementary) as currently provided in the hospital. SF-36™ Health Survey, short form Brief Pain Inventory, Visual Analogue Scale, and modified Client Service Receipt Inventory will be assessed at 4/5 time points. Semi-structured interview/focus group will be carried out before treatment, and 1 year after commence of treatment.</p><p><b>DISCUSSION</b>We intend to conduct a pragmatic observational study of integrated medical treatment of MSDs at a public sector hospital. It will inform the design of a future trial including recruitment, retention, suitability of the outcome measures and patients experiences.</p>

Out Of Hospital Cardiac Arrest In Kuala Lumpur: Incidence; Adherence To Protocol; And Issues: A Mixed Method Study

Information regarding out of hospital cardiac arrest incidence including outcomes in Malaysia is limited and fragmented. This study aims to identify the incidence and adherence to protocol of out of hospital cardiac arrest and also to explore the issues faced by pre-hospital personnel in regards to the management of cardiac arrest victim in Kuala Lumpur, Malaysia. A mixed method approach combining qualitative and quantitative study design was used. Two hundred eighty five (285) pre-hospital care data sheet for out of hospital cardiac arrest during the year of 2011 were examined by using checklists to identify the incidence and adherence to protocol. Nine semi-structured interviews and two focus group discussions were performed. Based on the overall incidence for out of hospital cardiac arrest cases which occurred in 2011 (n=285), the survival rate was 16.8%. On the adherence to protocol, only 89 (41.8%) of the cases adhered to the given protocol and 124 did not adhere to such protocol. All the relevant qualitative data were merged into few categories relating to issues that could affect the management of out of hospital cardiac arrest performed by pre-hospital care team. The essential elements in the handling of out of hospital cardiac arrest by pre-hospital care teamwasto ensure increased survival rates and excellent outcomes. Measures are needed to strengthen the quick activation of the pre-hospital care service, prompt bystander cardiopulmonary resuscitation, early defibrillation and timely advanced cardiac life support, and also to address all other issues highlighted in the qualitative results of this study.